Corrections

Question 1

1st line mx of acute pericarditis?

Answer 1

NSAIDs

Question 2

Side effects of adenosine?

Answer 2

• chest pain
• bronchospasm
• transient flushing
• feeling of doom

Question 3

Why should adenosine be avoided in asthmatics?

Answer 3

Due to possible bronchospasm

Question 4

Most common bacterial cause of endocarditis:

a) normally
b) <2 months post valve surgery

Answer 4

a) Staph. aureus

b) Staph. epidermis

Question 5

Conservative mx of NSTEMI:

a) high bleeding risk

b) not high bleeding risk

Answer 5

Aspirin plus:

a) clopidogrel
b) ticagrelor

Question 6

The most common type of coarctation of the aorta seen in adults is the postductal variety, i.e. the aortic narrowing is distal to the ductus arteriosus.

How does this affect UL and LL BP?

Answer 6

Upper limb BP > lower limb BP as the narrowing occurs after the left subclavian artery branches from the aorta.

Question 7

Can orthostatic hypotension be triggered by heavy meals?

Answer 7

Yes (postprandial hypotension)

Question 8

Does a new early diastolic murmur indicate aortic dissection affecting the ascending or descending aorta?

Answer 8

Ascending –> aortic regurgitation

Question 9

T wave inversion in which lead is a normal variant?

Answer 9

III

Question 10

ECG features of hypokalaemia?

Answer 10

• small or absent T waves (occasionally inversion)
• prolong PR interval
• ST depression
• long QT

Question 11

Mx of patients on warfarin with major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage) no matter what the INR?

Answer 11

Stop warfarin
IV vitamin K 5mg
PCC

Question 12

What is the definitive treatment of WPW?

Answer 12

radiofrequency ablation of the accessory pathway

Question 13

Surgical options for aortic stenosis:

a) low/medium operative risk patients
b) high operative risk patients

Answer 13

a) surgical AVR
b) transcatheter AVR

Question 14

If thrombolytic drugs are given during ALS, how long should CPR continue?

Answer 14

prolonged period of CPR (e.g. 60-90 mins) should be considered

Question 15

A lateral MI is generally caused by a lesion in what artery?

Answer 15

Left circumflex artery

Question 16

Mx of infective endocarditis causing congestive cardiac failure?

Answer 16

An indication for emergency valve replacement surgery

Question 17

What is the main ECG abnormality seen with hypercalcaemia?

Answer 17

Shortening of the QT interval

Question 18

Site of action of loop diuretics?

Answer 18

Ascending loop of Henle

Question 19

Mx of patients on warfarin if their INR becomes <2?

Answer 19

They needs immediate anti-coagulation with rapid acting LMWH.

Warfarin dose should be increased.

Question 20

Mx of angina in those with an inadequate response to verapamil (if beta blockers are contraindicated)?

Answer 20

Add a long acting nitrate e.g. isosorbide mononitrate

Question 21

What is torsades de pointes?

Answer 21

A form of polymorphic VT that occurs due to prolonged QT interval.

Question 22

Mx of VF/pulseless VT?

Answer 22

1) A single shock followed by 2 minutes of CPR

2) Amiodarone 300 mg should be given 3 shocks have been administered

3) A further dose of amiodarone 150 mg should be given after 5 shocks have been administered

Question 23

If a cardiac arrest is witnessed in a monitored patient (e.g. in a coronary care unit), what is mx?

Answer 23

up to 3 quick successive (stacked) shocks, rather than 1 shock followed by CPR

Question 24

Mx of non-shockable rhythms?

Answer 24

adrenaline 1 mg as soon as possible

Question 25

How to measure QT interval on an ECG

Answer 25

Time between start of Q wave and end of T wave

Question 26

How can mitral stenosis cause haemoptysis?

Answer 26

Due to increased pressures causing rupture of pulmonary vessels.

Question 27

What murmur does an ASD vs VSD cause?

Answer 27

ASD - ejection systolic, louder on inspiration VSD - pansystolic

Question 28

Target BP for T2D?

Answer 28

<14/90

Question 29

What is the main ECG abnormality seen with hypercalcaemia?

Answer 29

Shortening of the QT interval

Question 30

1st line mx of acute pericarditis?

Answer 30

Ibuprofen + colchicine

Question 31

When should ivabradine be considered in HF?

Answer 31

If the patient has sinus rhythm >75/min and a LV EF <35% and has not responded to triple therapy

Question 32

When should amiodarone be delivered in VF/pulseless VT?

Answer 32

300mg after 3 shocks further 150mg dose after 5 shocks

Question 33

Mx of torsades de pointes?

Answer 33

IV magnesium

Question 34

For a patient with hypertension who is already taking an ACEi, a history of gout would favour the addition of what?

Answer 34

CCB > thiazide diuretic

Question 35

How can pulmonary HTN be heard?

Answer 35

Loud S2 (due to loud P2)

Question 36

How is dextrocardia seen on an ECG?

Answer 36

1) inverted P wave in lead I 2) right axis deviation 3) loss of R wave progression

Question 37

Signs of tricuspid regurgitation?

Answer 37

- pansystolic murmur - prominent/giant V waves in JVP - pulsatile hepatomegaly - left parasternal heave

Question 38

Causes of tricuspid regurg?

Answer 38

1) RV infarction 2) pulmonary HTN e.g. COPD 3) rheumatic heart disease 4) infective endocarditis (especially IVDU) 5) Ebstein's anomaly 6) carcinoid syndrome

Question 39

Infective endocarditis most commonly affects what valve?

Answer 39

Mitral

Question 40

Infective endocarditis most commonly affects what valve in IVDU?

Answer 40

Tricuspid valve leading to regurg

Question 41

What is the intensity of the murmur in AR increased by?

Answer 41

Handgrip manouevre

Question 42

Most common cause of mitral stenosis?

Answer 42

Rheumatic fever

Question 43

What causes malar flush in mitral stenosis?

Answer 43

It is due to the back pressure of blood into the pulmonary system, causing a rise in CO2 and vasodilation.

Question 44

Describe murmur heard in MS

Answer 44

Mid-diastolic, low-pitched “rumbling” murmur (due to a low blood flow velocity). There is an opening snap after S2, which triggers the onset of the murmur.

Question 45

2 causes of mitral stenosis?

Answer 45

1) RHD 2) infective endocarditis

Question 46

Key complications of MS?

Answer 46

1) AF 2) Pulmonary HTN 3) Thromboembolism 4) Infective endocarditis

Question 47

How is infective endocarditis a complication of mitral stenosis?

Answer 47

Damaged mitral valve leaflets are more susceptible to infection.

Question 48

Where does the murmur radiate to in mitral regurgitation?

Answer 48

L axilla

Question 49

Long-term anticoagulation in biological valves?

Answer 49

Long-term anticoagulation not usually needed. Warfarin may be given for the first 3 months depending on patient factors. Low-dose aspirin is given long-term.

Question 50

What is the most common causative organism of infective endocarditis in patients following prosthetic valve surgery?

Answer 50

Coagulase-negative Staphylococci such as Staphylococcus epidermidis.

Question 51

Murmur in aortic stenosis vs aortic sclerosis?

Answer 51

Both valvular defects cause an ejection systolic murmur. In aortic sclerosis there is no radiation of the murmur to the carotids.

Question 52

How soon before surgery should warfarin be stopped?

Answer 52

5 days

Question 53

How will LV systolic dysfunction affect an aortic stenosis murmur?

Answer 53

Will result in a decreased flow-rate across the aortic valve and hence a quieter murmur.

Question 54

Target INR in mechanical valves: a) aortic valve b) mitral valve

Answer 54

a) 3.0 b) 3.5

Question 55

Investigation of choice in a suspected PE with a Wells PE score of ≤4?

Answer 55

D-dimer

Question 56

Investigation of choice in PE in renal impairment?

Answer 56

V/Q scan

Question 57

Most common cause of endocarditis: a) normally b) <2m post valve surgery

Answer 57

a) Staph. aureus b) Staph. epidermis

Question 58

Moderate to severe aortic stenosis is a contraindication to which med?

Answer 58

ACEi